Texas Medicaid Eligibility Guide 2026
Last updated: February 2026
Disclaimer: This guide provides general information about Medicaid eligibility and is not legal or financial advice. Eligibility rules can change, and individual circumstances vary. Always verify current requirements with Texas Health and Human Services before applying.
Getting health coverage in Texas can feel confusing, especially when you hear that millions of Texans are uninsured. The rules for Medicaid in Texas differ significantly from many other states, and understanding who actually qualifies can save you time and frustration.
Here's what you need to know upfront: Texas has not expanded Medicaid, which means most adults without children do not qualify regardless of how low their income is. However, children, pregnant women, seniors, and people with disabilities have broader eligibility. For example, a child under 6 can qualify with family income up to 144% of the federal poverty level, roughly $43,200 per year for a family of four. Parents face much stricter limits, qualifying only if income falls below about 12% of poverty, which amounts to approximately $230 per month for a single parent.
This guide breaks down exactly who qualifies for Texas Medicaid in 2026, what income limits apply to each group, and how to navigate the application process.
Why Texas Medicaid Is Different
Texas is one of ten states that has not expanded Medicaid under the Affordable Care Act. This decision has major consequences for residents seeking health coverage. In states that expanded Medicaid, adults can qualify with income up to 138% of the federal poverty level. In Texas, childless adults generally cannot qualify at any income level.
Approximately 4.2 million Texans receive Medicaid coverage as of mid-2025. The program covers specific categories of people including children, pregnant women, parents with very low income, elderly individuals, and people with disabilities. About 617,000 Texans fall into what experts call the "coverage gap." These individuals earn too little to qualify for Affordable Care Act marketplace subsidies (which require income of at least 100% of poverty) but do not fit the narrow categories eligible for Medicaid.
Texas has the highest uninsured rate in the nation at approximately 16%. Many uninsured Texans would qualify for coverage in expansion states but fall through the cracks under current rules.
Texas Medicaid Income Limits for Children and Pregnant Women
Children and pregnant women have the most accessible Medicaid eligibility in Texas. Income limits vary by the child's age, with younger children qualifying at higher income levels.
For children from birth through age 1, the income limit is 198% of the federal poverty level. This translates to approximately $4,957 per month or $59,484 per year for a family of four. Children ages 1 through 5 qualify at 144% of poverty, which is roughly $3,600 per month for a family of four. Children ages 6 through 18 can qualify if family income falls below 133% of poverty, about $3,325 per month for a family of four.
Pregnant women qualify for Texas Medicaid with income up to 198% of the federal poverty level. Coverage includes prenatal care, labor and delivery, and postpartum services. The coverage also extends to the baby after birth.
| Category | Income Limit (FPL %) | Family of 4 Monthly |
|---|---|---|
| Children 0 to 1 | 198% | $4,957 |
| Children 1 to 5 | 144% | $3,600 |
| Children 6 to 18 | 133% | $3,325 |
| Pregnant Women | 198% | $4,957 |
Children who do not qualify for Medicaid may still be eligible for CHIP, the Children's Health Insurance Program. CHIP covers children in families with income up to approximately 201% of the federal poverty level, filling the gap between Medicaid and families who can afford private coverage.
Texas Medicaid Income Limits for Parents
Parents face extremely strict income limits for Medicaid in Texas. The income threshold for parents and caretaker relatives is approximately 12% of the federal poverty level. For a single parent with two children, this means qualifying only if monthly income falls below about $230.
This threshold is one of the lowest in the nation. A parent working just 10 hours per week at minimum wage would likely exceed the income limit. Because of this restriction, very few Texas parents actually qualify for Medicaid coverage.
Parents who exceed the Medicaid income limit but earn below 100% of poverty often find themselves in the coverage gap. They earn too much for Medicaid but too little for ACA marketplace subsidies. This gap affects hundreds of thousands of Texas families each year.
The Texas Coverage Gap Explained
The coverage gap exists because of how the Affordable Care Act was originally designed. When Congress passed the ACA, it assumed all states would expand Medicaid to cover adults up to 138% of poverty. Marketplace subsidies were structured to help people earning between 100% and 400% of poverty. The gap between Medicaid and marketplace coverage was supposed to close through expansion.
When Texas chose not to expand Medicaid, adults earning less than 100% of poverty were left without options. A single adult earning $10,000 per year cannot get Medicaid in Texas and cannot get subsidies on the marketplace. They fall into the coverage gap.
Approximately 617,000 Texans fall into this gap according to recent estimates. These individuals often work in jobs that do not offer health insurance or work part-time hours. They may turn to community health centers, emergency rooms, or charity care when they need medical treatment.
If you fall into the coverage gap, you may want to explore community health centers that offer sliding-scale fees based on income. Federally Qualified Health Centers (FQHCs) across Texas provide primary care, dental services, and mental health treatment regardless of ability to pay.
Medicaid for Seniors and People with Disabilities
Elderly Texans and residents with disabilities have separate Medicaid eligibility rules. These programs use different income calculations and may include asset tests.
For SSI recipients, eligibility is automatic. If you receive Supplemental Security Income, you also qualify for Texas Medicaid without a separate application. The income limit for SSI is $994 per month for an individual as of 2026.
Nursing home Medicaid allows individuals with higher income to qualify if they need long-term care services. A single person can have income up to $2,982 per month and still qualify for nursing home coverage. Asset limits apply, with individuals allowed up to $2,000 in countable resources. Married couples have additional protections to prevent spousal impoverishment, including a community spouse resource allowance of up to $162,660.
Texas Medicaid includes a 60-month look-back period for asset transfers. If you gave away assets within five years of applying for nursing home Medicaid, those transfers may affect your eligibility.
How to Apply for Texas Medicaid
Texas uses a centralized benefits portal called YourTexasBenefits.com for Medicaid applications. This system handles applications for Medicaid, SNAP (food assistance), and TANF (cash assistance) all in one place.
You can apply online at YourTexasBenefits.com 24 hours a day. The online application walks you through questions about your household, income, and circumstances. You will need to provide information including Social Security numbers for all household members, proof of income such as pay stubs, proof of Texas residency, and identification documents.
You can also apply by phone by calling the Texas Health and Human Services helpline at 1-800-252-8263. Representatives can help you complete an application over the phone during business hours.
In-person applications are available at local HHSC offices throughout Texas. You can find your nearest office through the YourTexasBenefits website or by calling 2-1-1.
After you submit an application, Texas HHSC has up to 45 days to process your request and make a determination. You may be asked to provide additional documentation during this period. If approved, your coverage typically begins on the date of your application.
Check If You Might Qualify
Before spending time on a formal application, you can get a quick estimate of whether you might qualify for Medicaid and other benefit programs. Free screening tools ask a few questions about your household size, income, and circumstances, then show which programs you may be eligible for.
A tool like Benefits USA can check your potential eligibility for Texas Medicaid along with 10 other programs including SNAP, CHIP, and LIHEAP in about 5 minutes. These screeners provide estimates based on the information you enter. They cannot guarantee eligibility but help you understand what is available before you invest time in official applications.
Even if you do not qualify for Medicaid, you may qualify for other assistance programs that can help with food costs, utility bills, childcare, and healthcare for your children.
Frequently Asked Questions
Can adults without children get Medicaid in Texas? Generally no. Texas has not expanded Medicaid, so adults without children typically do not qualify regardless of income. Exceptions exist for adults who are pregnant, elderly, or have qualifying disabilities.
What is the income limit for a family of four to get Medicaid in Texas? It depends on who is applying. For children under 6, a family of four can earn up to about $3,600 per month. For parents, the limit is approximately $230 per month. The difference is substantial due to how Texas structures its eligibility categories.
How do I apply for Medicaid in Texas? Apply online at YourTexasBenefits.com, call 1-800-252-8263, or visit your local HHSC office. The online application is available 24 hours a day and handles multiple benefit programs at once.
What if I make too much for Medicaid but can't afford insurance? If your income is between 100% and 400% of the federal poverty level, you may qualify for subsidized health insurance through Healthcare.gov. If your income is below 100% of poverty and you do not qualify for Medicaid, you fall into the coverage gap. In this case, look into community health centers that offer sliding-scale fees.
Does Texas Medicaid cover dental and vision? Children on Texas Medicaid receive comprehensive dental and vision coverage. Adult dental and vision benefits are limited, though some managed care plans offer additional services.
How long does it take to get approved for Texas Medicaid? Texas HHSC processes applications within 45 days. If you need coverage urgently due to a medical emergency, expedited processing may be available.
Next Steps
Texas Medicaid eligibility depends heavily on which category you fit into. Children and pregnant women have relatively accessible income limits. Parents and childless adults face much more restrictive rules. If you or your children might qualify based on these income limits, applying is free and can provide valuable health coverage.
Start by checking your eligibility using a free screening tool, then gather your documents and submit an application through YourTexasBenefits.com. Even if you do not qualify for Medicaid, the same application can determine eligibility for SNAP and other programs that may help your family.
